Keratoconus

What is Keratoconus?

Keratoconus (KC) is a thinning disorder of the cornea that causes visual distortion. It causes the cornea to thin & bulge to a cone-like shape, distorting vision.

Keratoconus Symptoms

The earliest signs of keratoconus are usually blurred vision and frequent changes in eye glass prescription, or vision that cannot be corrected with glasses. Symptoms of keratoconus generally begin in late teenage years or early twenties, but can start at any time.

Other symptoms include:

• Increased light sensitivity
• Difficultly driving at night
• A halo around lights and ghosting (especially at night)
• Eye strain
• Headaches and general eye pain

Investigations

• Corneal topography and Pentacam: a computerized instrument that make three-dimensional “maps” of the cornea.

A typical corneal topography map looks like this:

Corneal topography and Pentacam has facilitated the diagnosis of keratoconus, helping establish the diagnosis earlier, follow progression more accurately and differentiate keratoconus from other conditions.

• ASOCT – This advanced investigation helps in knowing corneal thickness at different locations and to also see epithelial thickness profile which can be earliest indicator of keratoconus.

1. To Enhance Vision
• A) Spectacles - Small amount of astigmatism can be corrected by spectacle in early stages.
• B) Contact Lenses for Keratoconus - Keratoconus is managed by many different contact lens designs. No one design is best for every type of keratoconus. Since each lens design has its own unique characteristics, the lens fitter carefully evaluates the needs of the individual situation to find the lens that offers the best combination of visual acuity, comfort and corneal health.

2 Corneal Cross-linking - To Stop Progression of Keratoconus -

Corneal Collagen Cross linking (CXL) is currently the only treatment to stop progression of keratoconus and to avoid corneal transplant. CXL works by increasing collagen crosslink’s which are the natural “anchors” within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular. CXL has been done for over a decade with good success and has changed the way keratoconus is managed today. We are one of the pioneers of CXL treatments and offer all the techniques of CXL including accelerated cross linking and various combinations of CXL with vision enhancing techniques such as Topo PRK and INTACS.

Intacs Surgery for Keratoconus

Intacs is the trademark name for micro-thin prescription inserts which were previously used as a form of refractive surgery in the treatment of low levels of myopia or near sightedness, but has recently received FDA approval for keratoconus. Intacs are thin plastic, semi-circular rings inserted into the mid layer of the cornea. When inserted in the keratoconus cornea they flatten the cornea, changing the shape and location of the cone. The placement of Intacs remodels and reinforces the cornea, eliminating some or all of the irregularities caused by keratoconus in order to provide improved vision. This can improve uncorrected vision, however, depending on the severity of the KC, glasses or contact lenses may still be needed for functional vision.

Corneal Transplants

Although only 15-20% of those with keratoconus ultimately require corneal transplant surgery, for those who do, it is a crucial and sometimes frightening decision. However, those who know what to expect before, during and after surgery are better prepared and feel more in control of their health care. In keratoconus, a corneal transplant is warranted when the cornea becomes dangerously thin or when sufficient visual acuity to meet the individual’s needs can no longer be achieved by contact lenses due to steepening of the cornea, scaring or lens intolerance. Lens intolerance occurs when the steepened, irregular cornea can no longer be fitted with a contact lens, or the patient cannot tolerate the lens.